NW2 Combined Treatment Options QIA Review (Transplant and Home Therapies)

Transcription

1 NW2 Combined Treatment Options QIA Review (Transplant and Home Therapies) 1. Please select your facility from the dropdown list below; facility name and CMS Certification Number (CCN) have been included. 2. Has the Transplant QIA or Home Therapies QIA lead(s) changed since last survey submission? Yes No If yes, please submit new QIA lead(s) Name(s)and (s) here (Please indicate which QIA they are lead for). * 3. Name of person completing this form: * 4. Address: 5. When are Treatment Options (Home Therapies, Transplant) discussed in your facility? Lobby Day Patient Rounds Care Plan Meeting QIA Meeting Annually with every patient Depending on patient interest As needed Upon admission to our clinic Other (please specify) 1

2 NW2 Combined Treatment Options QIA Review (Transplant and Home Therapies) Transplant QIA Mid Point Evaluation (If your facility is not in the Transplant QIA, please skip to next page for The Home Therapies Section) 6. Think about all the steps leading up to TRANSPLANT (Step 1: Patient is eligible for transplant to Step 7: Patients is on the waitlist and/or inquiring about living donor transplant). Please list your patient population's top three (3) barriers to receiving a transplant: Barrier 1 Barrier 2 Barrier 3 N/A: Please describe why 7. Please indicate what you consider to be your facility's top three (3) successes in improving waitlist and/or transplant rates: Success 1 Success 2 Success 3 N/A (Describe why N/A) 8. Please summarize your facility's BEST PRACTICE in the Transplant QIA Project below (max 100 characters): (A best practice could be a one-time intervention or an on going modus operandi that you have done/ are doing at your facility that seems to be working for your patients regarding any step towards transplant) 2

3 9. Which of the following transplant centers does your facility most often refer patients to for transplant evaluation? Please select between 1 and 3 centers from the list below. Albany Medical Center, Albany Downstate Medical Center - SUNY, Brooklyn Erie County Medical Center, Buffalo Montefiore Hospital and Medical Center, Bronx Mt. Sinai Medical Center, New York NY Presbyterian Hospital/Columbia, Bronx NY Presbyterian Hospital/Weill Cornell, New York NYU Langone Hospital, New York North Shore University Hospital, Manhasset Strong Memorial Hospital University of Rochester, Rochester SUNY Health Sciences Center at Syracuse University Hospital, Syracuse Stony Brook University Hospital, Stony Brook Westchester Medical Center, Valhalla Other(s) (please specify) 10. In general, how would you describe your relationship with the Transplant Center(s) you mostly work with: Excellent Good Neutral Fair Poor 11. Please list the top three challenges/barriers you have with the transplant center(s) that you mostly work with Barrier 1 Barrier 2 Barrier 3 No barriers at all (Explain) 3

4 12. Please list your top three identified successes (if any) in your relationship with the Transplant Center(s) you work most with. Success 1 Success 2 Success 3 We have not identified any successes (Explain) NW2 Combined Treatment Options QIA Review (Transplant and Home Therapies) Home Therapies QIA Mid Point Evaluation (If your facility is not in the Home Therapies QIA, please skip to the next page) * 13. Think about all the steps leading up to HOME THERAPIES (Step 1: Patient Interest to Step 7: Patients Training). Please list your patient's the top three (3) barriers to Home Therapies: Barrier 1 Barrier 2 Barrier 3 We don't have any barriers (explain) * 14. Please indicate what you consider to be your facility's top three (3) successes in increasing patient utilization of Home Therapies: Success 1 Success 2 Success 3 N/A (Describe why N/A) 4

5 15. Please list you facility's Home Therapies Training Center We provide home training (PD and HHD) at our facility We refer to a sister facility for all home training We do not have a relationship with a home training facility We have patients find their own home training facilities if they want it : NW2 Combined Treatment Options QIA Review (Transplant and Home Therapies) Please Evaluate Network QIA Interventions * 16. Did you have patient feedback about your Treatment Options Education Station? Yes No Do not have an Education Station Please share brief comments 5

6 17. If you received feedback from patients, was it positive, neutral, or negative? Positive Neutral Negative : * 18. What has been the most challenging part of these QIAs for you? * 19. How many approximate hours per month do you spend on implementing strategies to assist patients with navigating the 7 steps? (Please provide a numerical value) Transplant QIA Interventions Home Therapies QIA Interventions * 20. What educational material(s)/resources do you wish were made available to assist you in this work? 21. Please rate the quality and usefulness of the following Network Interventions Poor/Not Useful Below Average Average Above Average Excellent N/A Transplant QIA Kickoff Webinar Home Therapies QIA Kickoff Webinar 6

7 Poor/Not Useful Below Average Average Above Average Excellent N/A 5 Whys Root Cause Analysis Webinar National Bi Monthly ESRD NCC CE QIA Webinars Treatment Options Education Station Guidelines QI and LEAN Techniques Webinar Monthly Home Therapies Newsletter 1:1 Calls and meetings to review facility needs and QIA progress Network Transplant Toolkit Home Therapies Webpage 7

8 Poor/Not Useful Below Average Average Above Average Excellent N/A Transplant QIA Webpage Network Monthly Newsletter Provider Insider Seven Step Tracker/Flyer Monthly Home Therapies QIA Feedback Worksheet Team Huddle Guidelines Thank you for completing this feedback form. We appreciate your time and effort. Plear responses to the Network. Quality Improvement Team IPRO ESRD Network of New York 8